If you’ve never heard of vaginismus at first skim it might appear as little more than a social media hashtag connoting witty female sayings. In reality, vaginismus is the inability or difficulty in allowing penetration of the vagina. The symptoms vary from discomfort, to burning or stinging with tightness during sex, to impossible penetration. Some women even have difficulty with the insertion of other objects, such as fingers, tampons or a speculum during a vaginal exam, but many are able to allow this sort of penetration, just not sex.
The cause is the involuntary tightening of the pubcoccygeus muscle (more commonly known as the “PC muscle” within the pelvic floor). Now, there are different types of vaginismus: primary and secondary. Women who have never been able to have sex without pain because of extreme vaginal tightness may be suffering from primary vaginismus. Women who develop painful tightening after years of pain-free sex could be suffering from secondary vaginismus.
According to Vaginismus.com, secondary vaginismus commonly “strikes women experiencing temporary pelvic pain problems such as urinary or yeast infections, pain from delivering babies, menopause, or surgery.” While the initial problem may be treated successfully, difficulties with sex may continue due to a conditioned response by the body.
Dr. Madeleine Castellanos, a New York-based sex therapist, explains the body’s response in secondary vaginismus this way:
What is almost universal in women with vaginismus is the creation of a vicious cycle that goes from difficulty with penetration with or without pain, to negative thoughts about it, to increased anxiety or fear, to avoidance and hypervigilance, to guarding and muscle contraction. This cycle continues to reinforce itself and becomes increasingly distressing for the individual and the couple. Because this vicious negative cycle complicates treatment and reinforces fear, the sooner that a woman receives treatment for vaginismus, the better.
Psychology has a definite role in vaginismus. Not only does anxiety about the problem and fear of experiencing pain exacerbate the problem – it can also be at the root of the initial onset of vaginismus. A fear of pregnancy, Castellanos notes, as well as anxiety over body issues, and fear of pain, can lead to the involuntary tightening of the pelvic floor. So too can stress, issues with a partner, emotional trauma, and childhood experiences.
Despite the role psychology plays in vaginismus, it is important to remember that it is involuntary, which means that it is not a woman’s fault. Just as often the reasons are physical; vaginismus can occur due to any sort of pelvic surgery, urinary tract infections, yeast infections, cysts, sexually transmitted illness, the use of certain medications (side effects), childbirth, menopause, sex with little or no foreplay, among others.
Often, it is a combination of things. As Castellanos suggests, the smartest thing to do if you should experience tightening that makes sex painful or impossible is seek immediate attention. A gynecologist can help isolate the trouble and begin laying out the groundwork for treatment. The good news is that this is a highly treatable issue. Dr. Castellanos elaborates on the treatment:
Dilators are almost always used as part of the treatment for vaginismus. Progressively wider and larger dilators are used by a woman at home to provide physical stretching of the entrance of the vagina. In using dilators, women also become increasingly comfortable with the sensation of penetration. This helps decrease anxiety, reassuring a woman that she can experience penetration under her control and without pain. Therapists work not only with the individual, but also with the couple so that the partner can gain understanding of the condition and be helpful once penetration is to be attempted.
As Castellanos points out, the treatment that addresses both the physical and psychological aspects of the problem is the best course of action.
FROM THE BLOGS
While Always Beginning the World does not exactly appear to be a case of vaginismus, the reaction she experienced when seeking medical assistance to treat what turned out to be a very thick sepate hymen, drives the point that often, a second and third opinion in dealing with such issues is essential:
When I was 22, I finally went to an OBGYN for the first time, to ask for birth control pills. I had heard they could help manage heavy periods. The doctor attempted a female exam on me. After a great deal of pain, shame, and embarrassment was suffered through, she finally gave up. She said my vagina was unusually small, she had no speculum small enough to work on me, and couldn’t even give me a pap smear. She said there was nothing to do about this issue, but sadly tampons would be out of the question for me, to say nothing of sex.
She said it like she was breaking the news to me that the milk in my refrigerator had gone bad; it was unfortunate news, to be sure; but she clearly saw no reason to cry over my extremely personal spilt milk.
She did, however, jot down a script for birth control pills that she handed me airily.
I left her office befuddled and numb. Over the course of the next 5 years I would see 4 more doctors, 3 of which were OBGYN’s and all of whom would provide the same diagnosis with the same lack of interest. No sex for you. Who’s next in the waiting room? One mentioned I had been "born wrong". Ahh, bless.
At Brighten the Path, Rachel tells her story of being unable to have sex for the first time on her wedding night (please note this post touches on sexual abuse in the last three paragraphs, and may be a trigger):
Several minutes in (hey, we were newlyweds!), Aaron attempted penetration. Nothing seemed to be happening so he pushed a little harder. All I could feel was pain and pressure. We tried several more times, ending frustrated and confused. Neither one of us got much sleep and even tried it again at different times throughout the night. I tried bracing myself against the nightstand with my foot, but it was no good. Nothing seemed to work.
The next day we both went to see a gynecologist, who was thankfully very kind and sympathetic. She confirmed that I did indeed have Vaginismus… I had to learn to relax my muscles to allow penetration and practiced penetration with vaginal dilators. This started on such a small level. I began by inserting a Q-Tip. After doing this several times, I tried using a small tampon again. This took several tries, but I was eventually able to get it. It was such a relief! After 3 agonizing months of practice, we were finally able to achieve penile penetration. I was so relieved and ecstatic!! The moment we had been waiting for for so long had finally come. We still had difficult times after that, but we knew it was too be expected.
Three years later, sex is still a struggle. There is still a lot of pain, at least during the initial penetration. Often times, I bleed as if though it is my first time. This is one of the issues I am working on in therapy. I've had to start all over again. This means using some new techniques and going back to using dilators while placing a moratorium on sex. I'm making a lot of progress, but trying very hard to take it slow. With something like this, failure can really set me back. It's a "3 steps forward, 2 steps back" kind of thing.
Over at Medical Center for Female Sexuality’s Better Sex blog, Bat Sheva Marcus discusses the experience of working to help heal vaginismus:
She came to us because she’s been married for 2 years and hasn’t been able to consummate her marriage. She worked seriously and in a focused way on her vaginismus while her husband struggled with the erectile dysfunction that often comes with vaginismus.
And they had intercourse for the first time last week!
Okay, it wasn’t perfect. She sat in our office explaining that it didn’t go too well. He wasn’t comfortable, she was nervous and awkward, he had a hard time maintaining an erection and there was little to no pleasure.
We sat together with the woman and her husband and went through all the possible mechanics that could get in the way or could help. We all laughed together as we discussed the awkwardness and reassured them that , yes, the first few times could be awkward, mechanical, uncomfortable and far from romantic. But we also reassured her that they would get there. She’s come so far – there’s no question in my mind that this loving couple will pull it all together. She is amazing in that no matter what the setback, she puts one foot in front of the other and moves ahead, with a smile that reveals the love and pleasure in her life.
They left holding hands.
And a powerful little post at Living With Vaginismus: “This will not define me. This will not define me. I will not let this define me.” Her whole blog is dedicated to her journey with vulvodynia and vaginismus.
AV Flox is the editor of Sex and the 405 -- what your newspaper would look like if it had a sex section.